Individual
BONNIE E KIRTLEY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
806 SAM HOUSTON SCHOOL RD, MARYVILLE, TN 37804-5632
(865) 719-8220
Mailing address
806 SAM HOUSTON SCHOOL RD, MARYVILLE, TN 37804-5632
(865) 719-8220
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
Primary
0000108064
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
TRV846765803
BLUE CROSS BLUE SHEILD
NE
Enumeration date
07/09/2019
Last updated
07/09/2019
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